Cardiac Resynchronization Therapy with Defibrillator in Ischemic Versus Nonischemic Cardiomyopathy
Goekhan Yuecel1,2, Leo Gaasch1, Svetlana Hetjens3
1Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University.
Insights
Cardiac resynchronization therapy with implantable cardioverter defibrillators (CRT-Ds) improves heart failure outcomes. Long-term functional status and remodeling benefits were observed regardless of whether the heart failure was ischemic or non-ischemic.
Area of Science:
- Cardiology
- Medical Devices
Background:
- Cardiac resynchronization therapy with implantable cardioverter defibrillators (CRT-Ds) is a standard treatment for heart failure (HF).
- Long-term outcomes and etiology-dependent differences in HF modification following CRT-D implantation require further investigation.
Purpose of the Study:
- To compare the long-term outcomes of CRT-D therapy in patients with ischemic cardiomyopathy (ICM) versus non-ischemic cardiomyopathy (NICM).
- To evaluate etiology-dependent differences in HF modification, including survival, left ventricular ejection fraction (LVEF), and hospitalizations.
Main Methods:
- Retrospective analysis of the Mannheim CArdiac Resynchronization TherApy RetrospeCtive ObservAtioNAl (MARACANA) Registry (2013-2021).
- Comparison of 380 CRT-D recipients, grouped into ICM (n=206) and NICM (n=174), based on survival, LVEF, HF hospitalizations, QRS width, and NYHA classification over a mean follow-up of 59.1 months.
Main Results:
- Patients with ICM were older, predominantly male, and had higher creatinine levels at baseline.
- Mean survival was better in the NICM group (54.4 months vs. 51.9 months).
- Both groups showed similar long-term improvements in NYHA classification and LVEF. ICM patients had more HF hospitalizations within the first year, while NICM patients exhibited more significant electrical remodeling.
Conclusions:
- CRT-D therapy offers long-term benefits in functional status and left ventricular reverse remodeling for heart failure patients, irrespective of the underlying etiology.
- Time- and etiology-associated comorbidities may influence specific aspects of HF modification following CRT-D implantation.
Abstract:
Cardiac resynchronization therapy with implantable cardioverter defibrillators (CRT-Ds) are established therapy options for patients suffering from heart failure (HF). Several aspects of HF modification have yet to be described regarding etiology-dependent outcome differences in the long-term.The Mannheim CArdiac Resynchronization TherApy RetrospeCtive ObservAtioNAl (MARACANA) Registry retrospectively included all patients provided with CRTs in our center from 2013 to 2021. CRT-D recipients (n = 380) were grouped to either ischemic cardiomyopathy (ICM, n = 206) or nonischemic cardiomyopathy (NICM, n = 174). Both groups were compared regarding survival, left ventricular ejection fraction (LVEF), hospitalizations due to HF, intrinsic and paced QRS width, NYHA classification, and several further aspects of HF modification in the long-term (59.1 ± 4.81 months).Patients with ICM were older (73.3 ± 8.4 versus 67.7 ± 10.8 years) and predominantly male (86.4 versus 74.7%) and presented with higher creatinine values (1.57 ± 0.92 versus 1.31 ± 0.66 mg/dL, each P < 0.05) at baseline. The mean survival for patients with NICM was better (51.9 ± 1.2 versus 54.4 ± 1.1 months, P = 0.03). Improvements in NYHA (2.93 ± 0.4 versus 2.79 ± 0.5-2.19 ± 0.7 versus 1.79 ± 0.7) and LVEF (26.4 ± 6.8 versus 27% ± 6.9% to 35.7 ± 9.6 versus 44 ± 11%, each P < 0.05) were similar for both groups after 5 years. Patients with ICM experienced more hospitalizations due to HF within the first year (odds ratio 1.9, P < 0.05), whereas electrical remodeling was more impressive for NICM (QRS width 157.1 ± 19.4 milliseconds versus intrinsic 116.6 ± 12.7 milliseconds and paced 131.9 ± 21 milliseconds after 5 years, both P < 0.05).Patients with HF might experience long-term improvements in functional status and left ventricular reverse remodeling following CRT-D, regardless of underlying etiology. Alterations in some aspects of HF modification could be influenced by time- and etiology-associated comorbidities.
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